Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain

Summary Outcomes

Potential beneficial outcomes:

  • Pain relief (with multiple measures of pain relief considered)
  • Reduced consumption of health-care resources (including medication)
  • Improved ability to engage in the activities of daily living
  • Improved quality of life
  • Patient satisfaction with treatment
  • Improvement in symptoms of depression
  • Return to work in patients whose uncontrolled chronic pain was the only impediment to gainful employment
  • Improved neurologic function might occur as an indirect benefit of pain control or discontinuation of other treatment (such as use of opioids)

Potential side effects:

  • A change in paresthesia corresponding to change in posture is normal and seldom causes a problem.
  • Extraneous paresthesia or motor responses usually can be avoided by careful electrode implantation and postoperative adjustment or by use of an insulated surgical plate/paddle electrode.
  • Unless it is a symptom of infection, pain/irritation from any component of the system can generally be treated topically, but surgical revision is necessary in some cases.

Risks associated with SCS:

  • Spinal cord or nerve injury
  • Dural puncture
  • Epidural hematoma
  • Infection

Possible complications:

  • Electrode migration causing loss of pain/paresthesia overlap (reassign contacts or revise electrode)
  • Implanted pulse generator failure (replace)
  • Electromechanical failure of lead or extension cable (replace)
  • Loss or reduction of pain relief despite paresthesia coverage of pain (can be treated with adjuvant medical therapy)